Diabetes: types and causes of its development, evolution and manifestations, how to treat, possible consequences

Diabetes mellitus is one of the most common diseases with a tendency to increase the incidence and spoil the statistics.The symptoms of diabetes mellitus do not appear overnight;the process is chronic, with an increase and worsening of endocrine and metabolic disorders.It is true that the onset of type 1 diabetes differs significantly from the early stage of type 2.

Among all endocrine pathologies, diabetes takes the lead and accounts for more than 60% of all cases.Furthermore, disappointing statistics show that 1/10 of “diabetics” are children.

The probability of acquiring the disease increases with age and, therefore, every ten years the size of the group doubles.This is due to the increase in life expectancy, the improvement of early diagnosis methods, the decrease in physical activity and the increase in the number of overweight people.

Types of diabetes

Many people have heard of such a disease as diabetes insipidus.So that the reader does not later confuse diseases called “diabetes”, it will probably be useful to explain their differences.

Diabetes insipidus

Diabetes insipidus is an endocrine disease that occurs as a result of neuroinfections, inflammatory diseases, tumors, intoxications and is caused by the insufficiency and sometimes complete disappearance of ADH-vasopressin (antidiuretic hormone)

This explains the clinical picture of the disease:

• Constant dryness of the oral mucosa, incredible thirst (a person can drink up to 50 liters of water in 24 hours, stretching the stomach to large sizes);
• Isolation of a large quantity of light, non-concentrated urine with low specific gravity (1000-1003);
• Catastrophic weight loss, weakness, decreased physical activity, digestive system disorders;
• Characteristic changes in the skin (“parchment” skin);
• Atrophy of muscle fibers, weakness of the muscular system;
• Development of dehydration syndrome in the absence of fluid intake for more than 4 hours.

In terms of complete cure, the disease has an unfavorable prognosis;working capacity is significantly reduced.

Brief Anatomy and Physiology

An unpaired organ, the pancreas, performs a mixed secretory function.Its exogenous part carries out external secretion, producing enzymes involved in the digestion process.The endocrine part, which is entrusted with the mission of internal secretion, produces several hormones, including -insulin and glucagon.They are essential to guarantee the consistency of sugar in the human body.

The endocrine section of the gland is represented by the islets of Langerhans, composed of:

1. A cells, which occupy a quarter of the total islet space and are considered the site of glucagon production;
2. B cells, occupying up to 60% of the cell population, synthesizing and storing insulin, whose molecule is a two-chain polypeptide, carrying 51 amino acids in a certain sequence;
3. Somatostatin-producing D cells;
4. Cells that produce other polypeptides.

Thus, the conclusion suggests itself:Damage to the pancreas and the islets of Langerhans, in particular, is the main mechanism that inhibits insulin production and triggers the development of the pathological process.

Special types and forms of the disease

Lack of insulin leads to impaired sugar constancy (3.3 – 5.5 mmol/l)and contributes to the formation of a heterogeneous disease called diabetes mellitus (DM):

• The complete absence of insulin forms (absolute deficiency)insulin dependentpathological process, calledtype I diabetes mellitus (IDDM);
• Lack of insulin (relative deficiency), which triggers a carbohydrate metabolism disorder at the initial stage, slowly but surely leads to the developmentnon-insulin dependentdiabetes mellitus (NIDDM), which is calledtype II diabetes mellitus.

Due to the disturbance in the use of glucose by the body and, consequently, its increase in the blood serum (hyperglycemia), which, in principle, is a manifestation of the disease, over time signs of diabetes mellitus begin to appear, that is, a total disturbance of metabolic processes at all levels.

In addition to type 1 and type 2 diabetes, there are special types of this disease:

1. Secondary diabetesresulting from acute and chronic inflammation of the pancreas (pancreatitis), malignant neoplasms in the parenchyma of the gland, liver cirrhosis.Various endocrine disorders accompanied by excessive production of insulin antagonists (acromegaly, Cushing's disease, pheochromocytoma, thyroid disease) lead to the development of secondary diabetes.Many long-term medications have a diabetogenic effect: diuretics, some antihypertensives and hormones, oral contraceptives, etc.;
2. Diabetes in pregnant women (gestational),caused by the peculiar mutual influence of the hormones of the mother, child and placenta.The fetal pancreas, which produces its own insulin, starts to inhibit the production of insulin by the maternal gland, resulting in the formation of this special form during pregnancy.However, with proper control, gestational diabetes usually disappears after birth.Subsequently, in some cases (up to 40%) in women with a similar pregnancy history, this fact may threaten the development of type II diabetes mellitus (within 6-8 years).

Why does “sweet” disease occur?

The “sweet” disease forms a rather “heterogeneous” group of patients, so it becomes obvious that IDDM and its non-insulin-dependent “brother” genetically originated differently.There is evidence of a connection between insulin-dependent diabetes and the genetic structures of the HLA (major histocompatibility complex) system, in particular, with some genes of the D region loci. For NIDDM, no such relationship has been observed.

For the development of type I diabetes mellitus, genetic predisposition alone is not sufficient;the pathogenetic mechanism is triggered by provoking factors:

• Congenital deficiency of the islets of Langerhans;
• Unfavorable influence of the external environment;
• Stress, nervous stress;
• Traumatic brain injuries;
• Pregnancy;
• Infectious processes of viral origin (flu, mumps, cytomegalovirus infection, Coxsackie);
• Tendency to constantly overeat, leading to excessive fat deposits;
• Abuse of confectionery products (those who like sweets are at greater risk).

Before addressing the causes of type II diabetes mellitus, it would be advisable to dwell on a very controversial question: who suffers more - men or women?

It is established that nowadays the disease occurs more frequently in women, although in the 19th century diabetes was a “privilege” of men.In fact, now in some Southeast Asian countries the presence of this disease in men is considered predominant.

Conditions predisposing to the development of type II diabetes mellitus include:

• Changes in the structural structure of the pancreas as a result of inflammatory processes, as well as the appearance of cysts, tumors, hemorrhages;
• Age after 40 years;
• Excess weight (the most important risk factor for NIDDM!);
• Vascular diseases caused by the atherosclerotic process and arterial hypertension;
• In women, pregnancy and birth of a child with high body weight (more than 4 kg);
• Have relatives with diabetes;
• Strong psycho-emotional stress (adrenal hyperstimulation).

The causes of illness in different types of diabetes in some cases coincide (stress, obesity, influence of external factors), but the beginning of the process in type 1 and type 2 diabetes is different, in addition,IDDM is the domain of children and young people, and non-insulin dependent people prefer the elderly.

Why do you want to drink so much?

The characteristic symptoms of diabetes mellitus, regardless of the form and type, can be presented as follows:

1. Dryness of oral mucous membranes;
2. Thirst that is practically impossible to quench, associated with dehydration;
3. Excessive formation of urine and its excretion through the kidneys (polyuria), which leads to dehydration;
4. Increased concentration of glucose in the blood serum (hyperglycemia), due to the suppression of the use of sugar by peripheral tissues due to insulin deficiency;
5. The appearance of sugar in the urine (glycosuria) and ketone bodies (ketonuria), which are normally present in insignificant quantities, but in diabetes mellitus they are intensively produced by the liver and, when excreted from the body, are found in the urine;
6. Increased content in blood plasma (in addition to glucose) of urea and sodium ions (Na⁺);
7. Weight loss, which in the case of decompensation of the disease is a characteristic feature of catabolic syndrome, which develops due to the breakdown of glycogen, lipolysis (mobilization of fats), catabolism and gluconeogenesis (transformation into glucose) of proteins;
8. Violation of lipid spectrum indicators, increase in total cholesterol due to the low-density lipoprotein fraction, NEFA (non-esterified fatty acids), triglycerides.The increasing content of lipids begins to be actively sent to the liver and there they are intensively oxidized, which leads to the excessive formation of ketone bodies (acetone + β-hydroxybutyric acid + acetoacetic acid) and their subsequent entry into the blood (hyperketonemia).Excessive concentration of ketone bodies threatens a dangerous condition calleddiabetic ketoacidosis.

Thus, the general signs of diabetes can be characteristic of any form of the disease, however, in order not to confuse the reader, it is still necessary to note the features inherent in one type or another.

Type I diabetes mellitus is a “privilege” of young people

IDDM is characterized by an acute onset (weeks or months).The signs of type I diabetes mellitus are pronounced and are manifested by clinical symptoms typical of this disease:

• Sudden weight loss;
• Abnormal thirst, the person simply cannot get drunk, although they try to do so (polydipsia);
• Large amounts of urine excreted (polyuria);
• Significant excess in the concentration of glucose and ketone bodies in the blood serum (ketoacidosis).At the initial stage, when the patient is not yet aware of his problems, the development of diabetic coma (ketoacidotic, hyperglycemic) is quite likely - an extremely life-threatening condition, therefore insulin therapy is prescribed as early as possible (as soon as diabetes is suspected).

In most cases, after using insulin, metabolic processes are compensated,The body's need for insulin decreases drastically and a temporary “recovery” occurs.However, this state of short-term remission should not relax either the patient or the doctor, as after some time the disease will remind itself again.Insulin requirements may increase as the duration of the illness increases, but generally, in the absence of ketoacidosis, will not exceed 0.8-1.0 U/kg.

Signs indicating the development of late complications of diabetes (retinopathy, nephropathy) may appear after 5 to 10 years.The leading causes of death from IDDM include:

1. Terminal renal failure, a consequence of diabetic glomerulosclerosis;
2. Cardiovascular disorders are complications of the underlying disease, which occur less frequently than kidney disorders.

Illness or age-related changes?(type II diabetes)

NIDDM develops over many months and even years.When problems arise, the person takes them to several specialists (dermatologist, gynecologist, neurologist...).The patient does not even suspect that different diseases, in his opinion: furunculosis, itchy skin, fungal infections, pain in the lower extremities are signs of type II diabetes mellitus.Patients become accustomed to their condition and diabetes continues to develop slowly, affecting all systems and especially blood vessels.

NIDDM is characterized by a stable and slow course, generally without a tendency to ketoacidosis.

Treatment of type 2 diabetes usually begins with a diet that limits easily digestible (refined) carbohydrates and the use of sugar-lowering medications (if necessary).Insulin is prescribed if the disease has progressed to the stage of severe complications or if there is resistance to oral medications.

The leading cause of death in patients with NIDDM is recognized as cardiovascular pathology resulting from diabetes.As a rule, this is a heart attack or stroke.

Treatments for diabetes mellitus

The basis of therapeutic measures aimed at compensating for diabetes mellitus is represented by three fundamental principles:

• Compensation for insulin deficiency;
• Regulation of endocrine and metabolic disorders;
• Prevention of diabetes, its complications and timely treatment.

The implementation of these principles is carried out based on 5 main positions:

1. Nutrition for diabetes mellitus plays the role of “first violin”;
2. An appropriate and individually selected physical exercise system accompanies the diet;
3. Sugar-lowering medications are primarily used to treat type 2 diabetes;
4. Insulin therapy is prescribed if necessary for NIDDM, but is essential in type 1 diabetes;
5. Train patients to self-monitor (skills to draw blood from a finger, use a glucometer, administer insulin without assistance).

Laboratory control above these positions indicates the degree of compensation after the following biochemical studies:

Indicators	Good level of remuneration	Satisfactory	Bad
Fasting glucose level (mmol/l)	4.4 – 6.1	6.2 – 7.8	Ø 7.8
Blood sugar content 2 hours after a meal (mmol/l)	5.5 – 8.0	8.1 – 10.0	Ø 10.0
Percentage of glycosylated hemoglobin (HbA1, %)	<8,0	8.0 – 9.5	Ø 10.0
Serum total cholesterol (mmol/l)	< 5.2	5.2 – 6.5	Ø 6.5
Triglyceride level (mmol/l)	<1,7	1.7 – 2.2	Ø 2.2

The important role of diet in treating NIDDM

Nutrition for diabetes mellitus is very well known, even to people far from diabetes mellitus, table number 9. While in the hospital for any illness, from time to time you can hear about a special diet, which is always in separate pans, different from other diets and is distributed after a certain password is said: “I have the ninth table”.What does this all mean?How is this mystery diet different from all the others?

It should not be mistaken, when caring for a diabetic who takes away his “porridge”, that he is deprived of all the joys of life.The diabetes diet is not that different from the diet of healthy people;patients receive the required amount of carbohydrates (60%), fats (24%) and proteins (16%).

Nutrition for diabetes consists of replacing refined sugars in food with slowly decomposing carbohydrates.Sugar sold in stores to everyone and confectionery products based on it fall into the category of prohibited foods.

As for nutritional balance, everything is strict here: diabetics must necessarily consume the necessary amount of vitamins and pectins, which must be at least 40 grams.per day.

Strictly individual physical activity

Physical activity for each patient is selected individually by the attending physician, taking into account the following points:

• Age;
• Symptoms of diabetes;
• The severity of the pathological process;
• The presence or absence of complications.

The physical activity prescribed by the doctor and carried out by the “ward” should promote the “burning” of carbohydrates and fats without involving insulin.Its dose, necessary to compensate for metabolic disorders, drops significantly, which should not be forgotten, as by avoiding an increase in blood sugar levels, an undesirable effect can be obtained.Adequate physical activity reduces glucose, the dose of insulin administered breaks down the remainder and, as a result, a decrease in sugar levels below acceptable values (hypoglycemia).

Like this,dosing insulin and physical activity requires a lot of attention and careful calculation,so that, complementing each other, together we do not exceed the lower limit of normal laboratory parameters.

Or maybe try folk remedies?

The treatment of type 2 diabetes mellitus is usually accompanied by the patient's own search for folk remedies that can slow down the process and delay the time it takes to take pharmaceutical forms as much as possible.

Despite the fact that our distant ancestors practically did not know about this disease, there are folk remedies for the treatment of diabetes mellitus, but we must not forget thatinfusions and decoctions prepared from various plants help.The use of home remedies for diabetes does not exempt the patient from following a diet, monitoring blood glucose, consulting a doctor and following all his recommendations.

To combat this pathology at home, well-known folk remedies are used:

1. White mulberry bark and leaves;
2. Oat grains and husks;
3. Walnut partitions;
4. bay leaf;
5. Cinnamon;
6. Acorns;
7. Nettle;
8. Dandelion.

When diet and folk remedies no longer help...

The so-called first generation medicines, widely known at the end of the last century, have become a thing of the past and have been replaced by new generation medicines, which make up the 3 main groups of diabetes medicines produced by the pharmaceutical industry.

The endocrinologist decides which medicine is suitable for this or that patient.And so that patients do not self-medicate and do not decide to use these diabetes medications at their own discretion, we will give several illustrative examples.

Sulphonylurea derivatives

Second generation sulfonylurea derivatives are currently prescribed, which act from 10 hours to 24 hours.Patients usually take them 2 times a day, half an hour before meals.

These medications are absolutely contraindicated in the following cases:

• Type 1 diabetes mellitus;
• Diabetic, hyperosmolar, lactic acidotic coma;
• Pregnancy, childbirth, lactation;

• Diabetic nephropathy accompanied by impaired filtration;
• Diseases of the hematopoietic system with a concomitant decrease in white blood cells - leukocytes (leukocytopenia) and the platelet component of hematopoiesis (thrombocytopenia);
• Severe infectious and inflammatory liver damage (hepatitis);
• Diabetes complicated by vascular pathology.

In addition, the use of drugs from this group can threaten the development of allergic reactions, manifested by:

1. Itchy skin and hives, sometimes leading to Quincke's edema;
2. Digestive system disorders;
3. Changes in the blood (decrease in platelet and leukocyte levels);
4. Possible impairment of the functional capabilities of the liver (cholestasis jaundice).

Antihyperglycemic agents from the biguanide family

Biguanides (guanidine derivatives) are actively used to treat type 2 diabetes mellitus, often adding sulfonamides to them.They are very rational for use by obese patients, however, for people with liver, kidney and cardiovascular pathologies, their use is quite limited, switching to milder medications from the same group or α-glucoside inhibitors, which inhibit the absorption of carbohydrates in the small intestine.

The following are considered absolute contraindications to the use of biguanides:

• DMID (type 1 diabetes mellitus);
• Significant weight loss;
• Infectious processes, regardless of location;
• Surgical interventions;
• Pregnancy, childbirth, breastfeeding;
• comatose states;
• Liver and kidney pathology;
• Lack of oxygen;
• Microangiopathy (2-4 degrees) with impairment of vision and kidney function;
• Trophic ulcers and necrotic processes;
• Poor circulation in the lower extremities due to various vascular pathologies.

Insulin treatment

From the above, it becomes obvious thatInsulin is the primary treatment for type 1 diabetes, all medical emergencies, and serious complications of diabetes.The NIDDM requires the indication of this therapy only in cases of forms that require insulin, when correction by other means does not produce the desired effect.

Modern insulins, called monocompetent, represent two groups:

1. Monocompetent pharmacological forms of human insulin substance (semisynthetic or recombinant DNA), which undoubtedly have a significant advantage over medicines of porcine origin.They have practically no contraindications or side effects;
2. Monocompetent insulins obtained from porcine pancreas.These drugs, compared to human insulins, require an increase in the dose of the drug by approximately 15%.

Diabetes is dangerous due to complications

Due to the fact that diabetes is accompanied by damage to various organs and tissues, its manifestations can be found in almost all systems of the body.Complications of diabetes mellitus are:

• Pathological changes in the skin: diabetic dermopathy, necrobiosis lipoidica, furunculosis, xanthomatosis, fungal infections of the skin;
• Osteoarticular diseases:
  1. Diabetic osteoarthropathy (Charcot joint - change in the ankle joint), occurring against the background of impaired microcirculation and trophic disorders, accompanied by dislocations, subluxations, spontaneous fractures preceding the formationdiabetic foot;
  
  2. Diabetic hairopathy, characterized by stiffness in the joints of the hands, which often develops in children with diabetes;
• Respiratory diseases: long termprolonged bronchitis, pneumonia,increased incidence of tuberculosis;
• Pathological processes affecting the digestive organs:diabetic enteropathy, accompanied by increased peristalsis, diarrhea (up to 30 times a day), loss of body weight;
• diabetic retinopathy– one of the most serious complications, characterized by damage to the visual organs;
• The most common complication of diabetes mellitus is considereddiabetic neuropathyand its variety -polyneuropathy, reaching 90% of all forms of this pathology.Diabetic polyneuropathy is a common conditiondiabetic foot syndrome;
• Pathological condition of the cardiovascular system, which in most cases is the cause of death from diabetes mellitus.Hypercholesterolemia and vascular atherosclerosis, which in diabetes begin to develop at a young age, inevitably lead to heart and vascular diseases (coronary artery disease, myocardial infarction, heart failure, stroke).

Prevention

Measures to prevent diabetes mellitus are based on the causes that cause it.In this case, it is advisable to talk about the prevention of atherosclerosis and high blood pressure, including combating excess weight, bad habits and food addictions.

Prevention of complications of diabetes mellitus involves preventing the development of pathological conditions resulting from diabetes itself.Correcting blood serum glucose, following a diet, engaging in adequate physical activity and following your doctor's recommendations will help delay the consequences of this rather formidable disease.